Ask Dr. Z

"Patient with thrombosed AV fistula was taken to Interventional Radiology. Ultrasound revealed a 5 cm segment of thrombus extending centrally from the arterial anastomosis. Venous limb of fistula is patent. Access was obtained directed towards arterial anastomosis, and infusion catheter was advanced to arterial anastomosis. tPA was pulsed into fistula under fluoro guidance, and tPA drip was started. Patient to return in one day for follow-up fistulogram. Impression: Successful initiation of thrombolysis therapy left upper extremity dialysis fistula." The department charged codes 37211 and 37212. Should this actually be reported with code 37211 only? In other cases by this radiologist he uses two infusion catheters in opposite directions, but in this case he uses only one. In an AV fistula, is it even appropriate to charge both codes 37211 and 37212 if two infusion catheters are used, one directed to the vein side and one to the arterial side?